Prognosis Of Coronary Artery Disease Patients Research Articles

Influence of Chromosome 9p21.3 rs1333049 Variant on Telomere Length and Their Interactive Impact on the Prognosis of Coronary Artery Disease.

Both telomere shortening and the chromosome 9p21.3 (Chr9p21) rs1333049 (G/C) variant are involved in coronary artery disease (CAD) risk, likely affecting mechanisms related to cell cycle arrest and vascular senescence. The aim of the study was to examine the link between Chr9p21 rs1333049 variant and leucocyte telomere length (LTL), as well as their interactive effect on the risk of major adverse cardiovascular events (MACEs). A cohort of 472 patients with angiographically proven and clinically stable CAD were included in the study. At baseline, the LTL, biochemical parameters, and genotype analysis of Chr9p21 rs1333049 variant were measured in all patients. The primary endpoint of this study was the occurrence of MACE defined as a composite of coronary-related death, nonfatal MI, and coronary revascularization. On multivariable linear regression analysis, age (p = 0.02) and Chr9p21 rs1333049 variant (p = 0.002) were the only independent predictors of LTL levels. Carriers of the CC genotype of this SNP had shorter telomeres than GC carriers (p = 0.02) and GG carriers (p = 0.0005). After a follow-up with a mean period of 62 ± 19 months, 90 patients (19.1%) had MACE. Short LTL was an independent prognostic factor of MACE incidence (HR:2.2; 95% CI: 1.3-3.7; p = 0.005) after adjustment for potential confounders. There was a significant interaction (p = 0.01) between the LTL and rs1333049 variant, with patients with risk-allele C and short LTL having a higher risk (HR:5.8; 95% CI: 1.8-19.2; p = 0.004). A strong relationship between LTL and Chr9p21 rs1333049 variant was identified, and they interactively affect the risk of poor prognosis in CAD patients.

Diabetes mellitus with mild or moderate kidney dysfunction is associated with poor prognosis in patients with coronary artery disease: A large-scale cohort study

AimBoth kidney dysfunction and diabetes mellitus (DM) predict long-term poor prognosis in patients with coronary artery disease (CAD). We aimed to evaluate the clinical outcomes according to the combined status of DM and different stages of kidney dysfunction in CAD patients. MethodsFrom January 2013 to December 2013, 9293 eligible patients hospitalized for percutaneous coronary intervention (PCI) at Fuwai hospital were followed up for major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause mortality, myocardial infarction and stroke. Baseline kidney function was considered as stage I: normal or high kidney function; stage II: mild dysfunction and stage III: moderate dysfunction according to estimated glomerular filtration rate (eGFR). Upon baseline kidney function, diabetic and non-diabetic patients were divided into six groups. ResultsDuring a median follow-up of 2.4 years, 326 (3.5%) MACCEs occurred. Compared to patients in the stage I/non-DM group, patients in the stage II/DM and stage III/DM groups had significantly increased MACCE risk [adjusted hazard ratio (aHR), 1.53; 95% confidence interval (CI), 1.09–2.15; P = 0.014; aHR, 3.00; 95%CI, 1.74–5.18; P < 0.002, respectively]. Additionally, there were J-shaped associations of eGFR with MACCE risk regardless of glycemic metabolism status after adjusted for confounders. Furthermore, moderate kidney dysfunction conferred an increased MACCE risk in diabetic patients with uncontrolled glycemia (aHR, 2.93; 95%CI, 1.48–5.78; P = 0.002). ConclusionsDM with mild or moderate kidney dysfunction is associated with poor prognosis in CAD patients. Categorical classification of patients with DM and kidney dysfunction could provide prognostic information for risk stratification of CAD patients.

Transcription factor 21 and prognosis in a coronary population

Abstract Introduction TCF21 is a member of the basic helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart. It regulates epicardium-derived cells differentiation into smooth muscle (SMC) and fibroblast lineages. The biological roles of TCF21 in epicardial fate determination and the progression of atherosclerosis remains a controversial issue. Purpose Investigate the impact of the TCF21 rs12190287 G&amp;gt;C variant on the prognosis of a coronary artery disease (CAD) cohort. Methods A prospective study was performed with 1,713 CAD patients (mean age 53.3±7.8; 78.7% male) surveyed in terms of MACE occurrence in an extended follow-up of 5.0±4.3. TCF21 rs12190287 was genotyped and analysed using the dominant model (GC+CC) and, subsequently, compared with the wild-type GG to evaluate the survival probability by Kaplan-Meier. A Cox regression analysis with all the risk factors and genetic models was performed to assess the independent variables associated with the prognosis of CAD patients. Results GG wild genotype was present in 9.5% of the population, GC in 43.2% and the risk genotype CC accounted for 47.3% of the CAD patients. The dominant model GC+CC showed a worse survival throughout the follow-up period. After multivariate Cox regression analysis, this model remained in the equation as an independent risk factor for MACE occurrence with an HR of 1.41 (p=0.033) together with multivessel disease, physical inactivity, chronic kidney disease (CKD) and diabetes. Conclusion TCF21 rs12190287 is a risk factor for prognosis in our population. The role of this gene may influence fundamental SMC processes in response to vascular stress, accelerating atherosclerosis progression and may represent a target for future therapies. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): SESARAM EPERAM

Associations Among Depression, Hemoglobin A1c Level, and Prognosis in Patients With Coronary Artery Disease: A Prospective Study.

BackgroundDepression is ubiquitous in patients with coronary artery disease (CAD). The relationship between depression and hemoglobin A1c (HbA1c) is controversial. The combined effect of high HbA1c and depression on prognosis is unclear, especially in non-diabetic CAD patients. We sought to explore these associations.Methods558 CAD patients were included in this prospective study. Patients were grouped by HbA1c levels and the status of clinical depression. The average follow-up period was about 2.2 years, and Cox proportional hazards models were used to compare the differences of prognosis in all the groups.ResultsClinical depression had no associations with HbA1c in all CAD patients (P for Pearson correlation = 0.74). In the all four groups, compared to group 1 (patients without clinical depression and low HbA1c), group 3 (without clinical depression and high HbA1c) had a higher risk of MACE (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.2–3.25) and composite events (aHR, 1.67; 95% CI, 1.09–2.053). Group 4 (patients with clinical depression and high HbA1c) had higher HRs for MACE (aHR, 2.9; 95%CI, 1.32–6.38) and composite events (aHR, 2.12; 95% CI, 1.06–4.25). In CAD patients without diabetes, patients with clinical depression and high HbA1c had a higher risk of MACE (HR, 2.71; 95% CI, 1.02–7.19), non-cardiac readmission (HR,3.48; 95% CI, 1.26–9.57) and composite events (HR,2.44; 95% CI, 1.08–5.53) than those with no clinical depression and low HbA1c. In patients with comorbidities of depression and diabetes, patients with depression and high HbA1c more likely to experienced non-cardiac readmissions (HR, 4.49; 95% CI, 1.31–15.38) than patients with no depression and low HbA1c only. In all the above analysis, p-values for interaction between clinical depression and HbA1c were not statistically significant.ConclusionsThe presence of both depression and high HbA1c lead to a worse prognosis in CAD patients than one risk factor alone, no matter with or without the comorbidity of diabetes in these CAD patients. For patients with CAD and depression, lower HbA1c may be required.

Diabetes mellitus in coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Morbidity and mortality are increased in patients with myocardial infarction that also have co-existing diabetes mellitus (DM) making it an important risk factor for coronary artery disease (CAD). Overall, diabetes mellitus worsens the prognosis in CAD patients. Purpose This paper was done from a study, that enabled us to measure the prevalence of diabetes mellitus in patients with coronary artery disease, in relevance to other CAD risk factors (age, gender, systolic blood pressure, LDL-C and smoking). These results would give us the ability to compare it with the outcomes of the EUROSPIRE IV study published in 2015 (1). Methods Retrospective observational study of consecutive patients from the Registry of Cyprus Heart Survey, examined in the Cardiology Clinic of Nicosia General Hospital, between the years 2011-14. The total number of patients was 371 (11.5% females and 88.4% males). These patients had a history of myocardial infarction and underwent either a PCI or a CABG. Results From the total amount of patients, 36.9% had history of diabetes mellitus. The percentage adjusted to gender shows that 44% of females and 35.6% of males included in the study had diabetes. The mean age of people that had diabetes and coronary artery disease was 68.65 (CI: 67.18, 70.12). The prevalence of diabetics with hypertension and coronary artery disease was 75.91% while the average systolic blood pressure (SBP) was 138 mmHg (CI: 135.33, 140.67). The systolic blood pressure was ≥140 mmHg in half of the diabetic individuals. Smoking was also assessed as a risk factor in patients with diabetes and CAD. The prevalence of ex-smokers was 28.46%, of smokers 18.24% and of non-smokers 53.28%. Finally, values of low density lipoprotein cholesterol (LDL-C) were measured in 90.5% of diabetic patients, 88.7% of them had an LDL-C ≥1.8 mmol/L (≥70mg/dL) and 53.22% had an LDL-C ≥2.5 mmol/L (≥100mg/dL). The average LDL-C value was 109.19 mg/dL. Conclusions The outcome of the study revealed that a substantial number of patients with CAD suffer from diabetes. Therefore, diabetes was verified as a major risk factor in patients with CAD and the development of acute coronary syndrome. Regarding those patients, other risk factors proved to have a negative impact on their cardiovascular health. Moreover, the risk factors in patients with DM and CAD of this study were compared with the well known study, EUROASPIRE IV (1). The prevalence of diabetes in the present study was 36.9%, compared to 26.8% in EUROASPIRE IV, indicating a higher prevalence in our study. We concluded that marked reduction in the events of myocardial infarction can be seen if we reduce the prevalence of uncontrolled diabetes mellitus occurrences with medication or better control of the risk factors of CAD early in the diagnosis to reduce complications.

Prognostic value of calcific aortic stenosis in patients of the PROGNOZ IBS registry

Aim. To assess the impact of calcific aortic stenosis on long-term prognosis in patients with stable coronary artery disease (CAD) included in the PROGNOZ IBS registry.Material and methods. The analysis included data of patients (n=541; men, 432; women, 109) from the CHD PROGNOSIS registry, in whom diagnosis of CAD was confirmed using coronary angiography during reference hospitalization in the National Medical Research Center for the period from January 1, to December 31, 2007. The mean age of men was 57,5±0,4, women — 60,9±0,9 years. The survival analysis included 504 patients (93%). The mean follow-up period was 7,3±2,19 years. We assessed the presence of calcific aortic stenosis (CAS) according to echocardiography and data on endpoints after 4 and 7 years of follow-up.Results. CAS according to echocardiography during reference hospitalization was found in 29 patients (5,4%) with a confirmed CAD. After four-year followup, 7 patients (24,1%) died, after 7 years — 15 (51,7%). Fatal and non-fatal cardiovascular events (primary endpoint) after 4 years were revealed in 10 patients (34,5%), and after 7 years, all cardiovascular events were fatal (n=15; 51,7%). In the presence of aortic stenosis, the relative risk (RR) of all-cause death at 4-year follow-up increased by 2,9 times (p&lt;0,01), while at 7-year follow-up — by 3,2 (p&lt;0,0001). The RR for the primary endpoint at 4-year follow-up increased by 2,8 times (p&lt;0,01), while at 7-year follow-up — by 2,3 times (p&lt;0,001). The RR of death in CAS patients at 7-year follow-up was comparable to severe heart failure — 3,3 (p&lt;0,01), stroke — 2,4 (p&lt;0,05) and left main coronary artery stenosis — 2,5 (p&lt;0,0001).Conclusion. The presence of calcific aortic stenosis had a pronounced negative effect on the long-term prognosis of CAD patients, comparable with those in left main coronary artery stenosis, severe heart failure and stroke.

Serum Levels of lncRNA CCHE1 and TCF21 in Patients with Coronary Artery Disease and Their Clinical Significances.

Objective To detect serum level changes of CCHE1 and TCF21 in coronary artery disease (CAD) patients and to explore their clinical significances. Patients and Methods. A total of 150 CAD patients were divided into the mild lesion group (n = 52), moderate lesion group (n = 48), and severe lesion group (n = 50), respectively, according to the Gensini score. In addition, they were divided into single vessel lesion (n = 42), two vessel lesions (n = 49), and three vessel lesions group (n = 59), respectively. Serum levels of CCHE1 and TCF21 in CAD patients were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Spearman's rank correlation was conducted to assess the relationship between levels of CCHE1 and TCF21 and severity and numbers of vessel lesions in CAD. Pearson's correlation test was used for analyzing the correlation between CCHE1 and TCF21 levels. A multivariable logistic regression test was performed to evaluate the influences of CCHE1 and TCF21 levels on CAD severity and the occurrence of cardiovascular events within 3 years of follow-up. Results Significant differences in incidences of diabetes and hypertension were identified in CAD patients divided according to CAD severity. In addition, significant differences in incidences of drinking, diabetes, and hypertension were identified in CAD patients divided according to numbers of vessel lesions. The serum level of CCHE1 was positively related to CAD severity and numbers of vessel lesions, while TCF21 displayed a negative relationship. During the 3-year follow-up, the incidence of cardiovascular events was 39.3% (59/150). CAD severity, numbers of vessel lesions, and serum levels of CCHE1 and TCF21 were independent factors influencing the occurrence of cardiovascular events in CAD patients. Conclusions The increased serum level of CCHE1 and decreased TCF21 level are closely related to CAD severity, which are able to influence the prognosis in CAD patients.

Níveis mais Baixos de Fetuína-A Sérica estão Associados a um Maior Risco de Mortalidade em Dez Anos em Pacientes com Infarto do Miocárdio por Supradesnivelamento do Segmento ST

ResumoFundamento A fetuína-A é um fator anti-inflamatório e anticalcificação envolvido no curso da doença arterial coronariana (DAC). Em alinhamento com essas funções, investigou-se a fetuína-A como marcador de risco cardiovascular em vários estudos. Porém, a associação entre a fetuína-A e o prognóstico dos pacientes com DAC ainda é controversa.Objetivos O presente estudo foi conduzido para identificar a associação entre o nível de fetuína-A sérica e doença cardiovascular (DCV) de longo prazo e a mortalidade global por infarto do agudo do miocárdio por supradesnivelamento do segmento ST (STEMI).Métodos Foram cadastrados no estudo cento e oitenta pacientes consecutivos com STEMI. A população do estudo foi dividida em subgrupos (mais baixo, ≤288 µg/ml; e mais alto, >288 µg/ml) de acordo com a mediana do nível de fetuína-A. Dados de acompanhamento clínico foram obtidos por contato telefônico anual com pacientes ou familiares. As causas das mortes também foram confirmadas pelo banco de dados de saúde nacional. P-valores bilaterais <0,05 foram considerados estatisticamente significativos.Resultados Durante um acompanhamento médio de 10 anos, foram registradas 71 mortes, das quais 62 foram devidas a DCV. Identificou-se um índice de mortalidade global e por DCV significativamente mais alto no grupo com nível de fetuína-A mais baixo que no grupo com nível de fetuína-A mais alto (44% versus 24%, p= 0,005; 48% versus 31%, p= 0,022, respectivamente). Nas análises de risco proporcionais por regressão de Cox, detectou-se que a fetuína-A era um preditor independente de mortalidade global e por DCV.Conclusões A baixa concentração de fetuína-A está associada ao prognóstico de longo prazo ruim pós-STEMI, independentemente de fatores de risco cardiovascular tradicionais. Nossos achados fortaleceram estudos prévios demonstrando consistentemente o papel determinante dos mediadores anti-inflamatórios em síndromes coronárias agudas.

Prognostic impact of malnutrition on cardiovascular events in coronary artery disease patients with myocardial damage

BackgroundStable coronary artery disease (CAD) patients with myocardial damage have a poor prognosis compared to those without myocardial damage. Recently, malnutrition has been reported to affect the prognosis of cardiovascular diseases. However, the effects of malnutrition on prognosis of CAD patients with myocardial damage remains uncertain. We investigated the effects of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI).MethodsSubjects comprised 241 stable CAD patients with myocardial damage due to myocardial ischemia or infraction. Patients underwent successful revascularization for the culprit lesion by PCI using second-generation drug-eluting stents and intravascular ultrasound. The geriatric nutritional risk index (GNRI), which is widely used as a simple method for screening nutritional status using body mass index and serum albumin, was used to assess nutritional status. Associations between major cardiovascular and cerebrovascular events (MACCE) and patient characteristics were assessed.ResultsMean GNRI was 100 ± 13, and there were 55 malnourished patients (23%; GNRI < 92) and 186 non-malnourished patients (77%). MACCE occurred within 3 years after PCI in 42 cases (17%), including 34 deaths (14%), and the malnourished group showed a higher rate of MACCE (38%) compared with the non-malnourished group (11%, p < 0.001). Univariate Cox proportional hazards analyses showed that MACCE was associated with age [hazard ratio (HR), 1.04; 95% confidence interval (CI), 1.04–1.07; p = 0.004], prior heart failure (HR 2.35; 95% CI 1.10–5.01; p = 0.027), high-sensitivity C-reactive protein (HR 1.08; 95% CI 1.03–1.11; p < 0.001), hemodialysis (HR 2.63; 95% CI 1.51–4.58; p < 0.001) and malnutrition (HR 3.69; 95% CI 2.11–6.42; p < 0.001). Multivariate Cox proportional hazards analysis revealed hemodialysis (HR 2.17; 95% CI 1.19–3.93; p = 0.011) and malnutrition (HR 2.30; 95% CI 1.13–4.67; p = 0.020) as significantly associated with MACCE. Furthermore, Cox proportional hazards models using malnutrition and hemodialysis revealed that patients with malnutrition and hemodialysis were at greater risk of MACCE after PCI than patients with neither malnutrition nor hemodialysis (HR 6.91; 95% CI 3.29–14.54; p < 0.001).ConclusionsIn CAD patients with myocardial damage, malnutrition (GNRI < 92) represents an independent risk factor for MACCE. Assessment of nutritional status may help stratify the risk of cardiovascular events and encourage improvements in nutritional status.

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &amp;lt;13.0g/dl for male and &amp;lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &amp;lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&amp;lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&amp;lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&amp;lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&amp;lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&amp;lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&amp;lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&amp;lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&amp;lt;0.0001; IAP: 2.67 [2.06–3.47], p&amp;lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

Acute glycemic variability on admission predicts the prognosis in hospitalized patients with coronary artery disease: a meta-analysis.

Increased glycemic variability has been related with poor prognosis in patients with coronary artery disease (CAD). However, whether diabetic status or subtype of CAD could affect the association remains unknown. We performed a meta-analysis to systematically evaluate the association between the mean amplitude of glycemic excursions (MAGE) on continuous glucose monitoring and the incidence of major adverse cardiovascular events (MACEs) in CAD patients. Relevant prospective cohort studies were identified through search of PubMed, Embase, WanFang, and CNKI databases. A random-effect model was used to pool the results. Subgroup analyses were performed to evaluate the influences of the predefined study characteristics on the outcome. Eleven cohort studies with 2666 hospitalized patients with acute coronary syndrome (ACS) or stable CAD for percutaneous coronary intervention were included. Pooled results showed that higher MAGE at admission was associated with higher incidence of MACEs during follow-up (adjusted relative risk [RR]: 1.84, p < 0.001; I2 = 12%). Stratified analyses showed that the association between higher MAGE and higher risk of MACEs in CAD patients were consistent in patients with or without diabetes, and in those with ACS or stable CAD (p for subgroup difference both >0.05). Significant publication bias was detected (p = 0.041). Trim-and-fill analysis retrieved three studies to generate symmetrical funnel plots. Meta-analysis that incorporated these studies showed similar results (RR: 1.80, p < 0.001). Increased glycemic variability may be associated with poor prognosis in CAD patients regardless of the diabetic status and the subtype of CAD.

Risk factor control and medical therapy of coronary artery disease in Taiwan - Review and Recommendations - Part III: Blood sugar management for patients with coronary artery disease

Cardiovascular disease (CVD) is the leading cause of death in the world and the second important cause of death in Taiwan. Atherosclerosis CVD (ASCVD) especially coronary artery disease (CAD) is the major cause of CVD [1]. Clinically, the presentation of CAD can be divided into acute unstable disease, so-called acute coronary syndrome (ACS) and chronic stable disease. Up to now, the main risk factors for CAD are known as hyperlipidemia, hypertension, hyperglycemia, smoking and family history. The control of the above risk factors and lifestyle modifications can improve the prognosis of CAD patients [1,2]. Here, we described the blood lipid control, blood pressure control, blood glucose control, and lifestyle modifications for CAD in Taiwan. The followings are the part III for blood glucose control. Type 2 Diabetes mellitus (T2DM) has been suggested a CAD equivalent. The risk of CAD may be correlated with the baseline HbA1c. Numerous studies have demonstrated the benefits of controlling modifiable CV risk factors in people with diabetes. Therefore, in patients with documented CAD, DM control is recommended.Because the benefits of intensive glucose control emerge slowly, while the harms can be immediate, people with longer life expectancy have more to gain from intensive glucose control. The 4 randomized clinical trials (RCTs), including UKPDS, ACCORD, ADVANCE, VADT trials, or large meta-analyses, testing intensive glucose control vs. conventional glucose control did not show positive results in reducing major adverse cardiovascular events (MACE) in individual trials. There are also lack of HbA1c target CV outcome trials in patients with CAD. The impact of glucose control on macrovascular complications is less certain. In the consensus, glycemic treatment targets should be individualized based on patient characteristic, including frailty and comorbid conditions, and risk of adverse effects of therapy (e.g., hypoglycemia and weight gain), to balance the benefit and risks of glycemic control, rather than the strengthen the HbA1c target in patients with documented CAD.

P3626Malnutrition is a major factor to affect prognosis of coronary artery disease patients with myocardial damage

Abstract Background Malnutrition is the important factor to cause frailty and sarcopenia which affect the prognosis of cardiovascular diseases. However, the effect of malnutrition on prognosis of coronary artery disease (CAD) patients with myocardial damage is still uncertain. Purpose The aim of the present study was to investigate the effect of malnutrition on prognosis of CAD patients with myocardial damage who received percutaneous coronary intervention (PCI). Methods The subjects were 241 CAD patients with myocardial damage due to myocardial ischemia by coronary artery stenosis or occlusion. These patients underwent successful revascularization for CAD by PCI using second-generation drug eluting stents and discharged. Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional status in this study, and patients with GNRI&lt;92 at baseline were defined as malnutrition group. The association between MACCE (major cardiovascular and cerebrovascular events) after discharged and patient's characteristics including nutritional status at baseline were assessed. Results The mean follow-up period was 546±310 days, with a maximum follow-up duration of 1092 days. MACCE within 3 years after PCI were 42 cases (17%) and malnutrition group had high rate of MACCE (38 vs. 11%, P&lt;0.01) compared with non- malnutrition group. In malnutrition group, age (77±9 vs. 67±11 years, P&lt;0.01) and high-sensitivity C-reactive protein (hs-CRP) level (5.52±6.63 vs. 0.72±1.86 mg/dl, P&lt;0.01) were higher than those of non-malnutrition group. The serum albumin (Alb) level (3.0±0.5 vs. 4.0±0.4 mg/dL, P&lt;0.01), hemoglobin (Hb) (10.4±1.9 vs. 12.8±2.4 g/dL, P&lt;0.01), total cholesterol (151.8±32 vs. 174.1±41.6 mg/dL, P&lt;0.01), triglycerides (96.9±49.1 vs. 140.6±128.3 mg/dL, P&lt;0.01), and left ventricular ejection fraction (LVEF) (50.2±15.9 vs. 55.9±15.3%, P=0.03) were lower in malnutrition group than those in non-malnutrition group. Moreover, malnutrition group had lower rate of hemodialysis (HD) (35 vs. 65%, P&lt;0.01), dyslipidemia (16 vs. 84%, P&lt;0.01) and using of statins (16 vs. 83%, P=0.02) than those in non-malnutrition group. As a result of Cox proportional hazards analysis, MACCE was associated with age [hazard ratio (HR): 1.04, 95% confidence interval (CI): 1.01–1.07, p p&lt;0.01)], hs-CRP (HR: 1.08, 95% CI: 1.03–1.11, p&lt;0.01), HD (HR: 2.63, 95% CI: 1.51–4.58, p&lt;0.01) and malnutrition (HR: 3.69, 95% CI: 2.11–6.42, p&lt;0.01) in the univariate analysis. The multivariate Cox proportional hazards analysis revealed that HD (HR: 2.24, 95% CI: 1.24–4.08, p&lt;0.01) and malnutrition (HR: 2.10, 95% CI: 1.04–4.23, p=0.03) were significantly associated with MACCE. Furthermore, malnutrition additively facilitated incidence of MACCE among patients underwent HD (GNRI &lt;92+HD: HR 4.19, 95% CI: 2.22–7.88, p&lt;0.001, GNRI &gt;92+HD: HR 1.26, 95% CI: 0.65–2.47, p=0.493). Conclusions In CAD patients with myocardial damage, malnutrition (GNRI&lt;92) is a major risk factor for MACCE after PCI.

Association between fetuin-A and prognosis of CAD: A systematic review and meta-analysis.

Fetuin-A is an anti-inflammation and anti-calcification factor involved in the course of coronary artery disease (CAD). But the association between serum fetuin-A level and the prognosis of CAD patients was still controversial. To clarify the association between serum fetuin-A level and the prognosis of CAD patients, we conducted the present meta-analysis. The included studies should be potentially relevant prospective studies published in English language before January 2019. The target population of the present meta-analysis was restricted to patients with CAD. The results of studies must report hazard ratio (HR) or Kaplan-Meier survival curve for all-cause mortality or incidence of secondary cardiovascular disease (CVD) events. The pooled HRs were analysed by the method of meta-analysis. A total of four prospective studies, including 4256 participants with CAD disease, were chosen to be included. The pooled HR for all-cause mortality was 0.57 (95% CI: 0.37-0.87), showing a statistically significant association between high serum fetuin-A level and low all-cause mortality in CAD patients. For the incidence of secondary CVD events, the pooled HR was 0.86 (95% CI: 0.60-1.23), indicating no statistically significant association between serum fetuin-A level and incidence of secondary CVD events in CAD patients. High serum fetuin-A level associated with lower all-cause mortality in patients with CAD. No association between serum fetuin-A level and incidence of secondary CVD events was found in patients with CAD.

Eicosapantaenoic acid treatment based on the EPA/AA ratio in patients with coronary artery disease: follow-up data from the Tochigi Ryomo EPA/AA Trial in Coronary Artery Disease (TREAT-CAD) study.

Eicosapentaenoic acid (EPA) administration has been reported to decrease the incidence of cardiovascular events, and the serum EPA/arachidonic acid (AA) ratio has been identified as a potential new risk marker for coronary artery disease (CAD). The present study aimed to investigate the value of EPA treatment based on the EPA/AA ratio at baseline. We retrospectively analyzed clinical outcome data from 149 CAD patients with a baseline EPA/AA ratio ≤ 0.4 who had received purified EPA (EPA group) or not (no EPA group) and CAD patients with an EPA/AA ratio > 0.4 who had not received EPA (control group). The baseline EPA/AA ratios were similar in the EPA and no EPA groups and were significantly lower than those in the control group (P < 0.0001). The EPA/AA ratio significantly increased in the EPA group (P < 0.0001) and the no EPA group (P < 0.001) but not in the control group. The cumulative incidence of cardiovascular death tended to be lower in the EPA group (log-rank test: P = 0.07). Receiver operating characteristic curve analysis demonstrated that the cut-off value of the target EPA/AA ratio after EPA treatment for all-cause death was 1.23 (AUC = 0.85, P = 0.016). These results suggest that EPA treatment may improve the long-term prognosis in CAD patients with an EPA/AA ratio ≤ 0.4 and that an EPA/AA ratio > 1.2 may be an appropriate EPA treatment target value to reduce mortality.

Subclinical hypothyroidism is associated with lipid-rich plaques in patients with coronary artery disease as assessed by optical coherence tomography.

BackgroundSubclinical hypothyroidism (SCH) has recently been acknowledged as an unconventional risk factor for coronary artery disease (CAD) and characterized by poor prognosis, which may be due to atherosclerotic plaque characteristics. We conducted this study to observe coronary plaque characteristics in coronary artery disease patients with concomitant SCH.MethodsPatients with coronary artery disease were enrolled in the study and divided into an SCH group (patients, n = 26; plaques, n = 35) and a non-SCH group (patients, n = 52; plaques, n = 66). They were divided 1: 2 according to propensity-matched analysis including age, diabetes mellitus, gender, CAD severity and culprit vessel. Optical coherence tomography (OCT) imaging was performed on all patients, and images were analyzed by two independent investigators. Lipid-rich plaques (LRP), the precursor of vulnerable plaques, were defined as having more than one quadrant occupied with lipid pool. Maximum lipid arcs were simultaneously recorded. Fibrotic plaques and calcific plaques were also identified. The presence of coronary dissection, plaque erosion, thrombus, macrophage, calcific nodule, thin-cap fibroatheroma and micro channel were all noted.ResultsThe ratio of LRP in SCH group was significantly higher than that in non-SCH group (54% vs. 30.3%, P = 0.037). That was the case as well for the maximum lipid arcs value (181.5° ± 61.6° vs. 142.1° ± 35.9°, P = 0.046). While thin-cap fibroatheroma (TCFA) was detected, no difference was identified between the two groups in either TCFA ratio (20% vs. 16.7%, P = 0.579) or fibrous cap thickness (57.5 ± 14.0 vs. 63.5 ± 10.7 µm, P = 0.319). Other OCT characteristics such as dissection, plaque erosion, thrombus, macrophage shadow and calcific nodule were also similar.ConclusionHigher ratio of LRP with greater lipid arc in SCH patients may be related to the plaque instability and poor prognosis in CAD patients with SCH.

Abstract P112: Coronary RevascularizationProcedure Mortality in Coronary Artery Disease Patients With End-Stage Renal Disease: Do Racial Disparities Matter?

Background: Studies have demonstrated that chronic kidney disease (CKD), especially its last stage - end-stage renal disease (ESRD) - is not only an independent risk factor for coronary artery disease (CAD), but it also worsens survival prognosis in CAD patients. It remains unclear whether racial disparities affect the outcomes of coronary revascularization procedures - coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) - in CAD patients with ESRD (CAD-ESRD). Study Objectives: (1) to investigate comparative effectiveness of CABG and PCI on in-hospital mortality outcomes in CAD-ESRD patients and (2) to investigate racial disparities in the utilization and in-hospital mortality outcomes of CABG and PCI in CAD-ESRD patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 23,519 CAD-ESRD patients [mean + SD age: 65.4 + 11.6 years; 62.2% (14,626 of 23,519) males] after CABG and PCI during 2007-2011. Patient race was defined as white, black, Asian, or Native American. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression (MLR), adjusted for known clinical, demographic, and socio-economic covariates. Results: In the covariate-adjusted MLR analysis, post-PCI in-hospital mortality in CAD-ESRD patients was significantly lower than post-CABG mortality (adjusted OR = 0.47, 95% CI: 0.41-0.53, p&lt;0.001). Post-procedure mortality was associated with emergency room (ER) admission (adjusted OR 1.62, 95% CI: 1.44-1.83, p&lt;0.001), older age (3.2% increase for each year, 95% CI: 2.6-3.8%, p&lt;0.001), and higher severity of co-existing conditions other than ESRD measured by the Elixhauser Comorbidity Index (8.5% increase for each point increase in the modified Elixhauser-Walraven score, 95% CI: 7.5-9.5%, p&lt;0.001). Blacks were more likely to undergo an ER admission (48.4%) than Asians (46.0%), Native Americans (43.2%) or whites (42.4%, p&lt;0.05, with multiple comparison correction). In the adjusted MLR analysis, race was not a statistically significant independent predictor of post-procedure mortality. C-statistic for the MLR was 0.729. Conclusions: Our results suggest that in-hospital post-PCI mortality in CAD-ESRD patients is lower than post-CABG mortality. Racial disparities in ER admissions - a demonstrated predictor of post-procedure mortality in these patients - may reflect the underlying racial disparities in access to and utilization of primary care. Further studies investigating disparities in CAD-ESRD mortality are warranted.

Hospital-based phase III cardiac rehabilitation program improves low density lipoprotein, triglyceride, and fasting blood glucose levels in coronary artery disease patients

ABSTRACT Background. Cardiac rehabilitation (CR) has been reported as effective for improving coronary risk factors and increasing exercise tolerance in patients with coronary artery disease (CAD) after cardiac events. It may be performed in 3 stages: acute (phase I), subacute (phase II), and chronic (phase III). In Indonesia, most cardiac rehabilitation programs have been phase I and some phase II, whereas phase III cardiac rehabilitation has not often been performed as it was not covered by national health insurance. Objectives . We assessed the beneficial effects of 6-month hospital-based phase III comprehensive cardiac rehabilitation on physical status and coronary risk factors among CAD patients. Methods . 74 patients were stratified as the intervention group (n=37) and the control group (n=37). In the intervention group, patients participated in hospital-based phase III CR for 6 months, whereas in the control group, they received standard care. CR program consists of warm-up ( senam jantung sehat ), aerobic exercise, cool-down stretching, and health education session three days a week. Blood glucose and lipid profile examination were performed at the beginning and sixth month to assess patient’s metabolic status. Results . Of 74 patients observed, most patients were male (85.1%) with mean age 54.7 + 3.4 years old. 57 patients had post-procedural history (77% post-PCI, 4% post-CABG), 8 patients (11%) were still active smokers, 31 patients (42%) had diabetes, and 60 patients (81%) had hypertension. Participation of hospital-based phase III CR program was significantly correlated with lower low-density lipoprotein (LDL) level (p=0.003, r =0,41), triglyceride level (p=0.001, r =0,38), and fasting blood glucose (p<0.001, r =0,46) during 6-month follow up. Conclusion . Patients with CAD who underwent hospital-based phase III CR program had significantly better fasting glucose control, LDL, and triglyceride level during 6-month follow up. These results may encourage other hospitals to perform the same program achieving better prognosis of CAD patients. Keywords : cardiac rehabilitation, high density lipoprotein, low density lipoprotein, triglyceride, blood glucose

Relationship between asymptomatic intra-cranial lesions and brachial-ankle pulse wave velocity in coronary artery disease patients without stroke.

Little is known about the significance of asymptomatic intra-cranial lesions (ICL) identified by brain MRI in coronary artery disease (CAD) patients. Silent cerebral lesions are suggested to be associated with arterial stiffness in healthy subjects. We investigated whether subclinical ICL are associated with arterial stiffness and the prognosis in CAD patients without medical history of cerebrovascular diseases. We recruited CAD patients who required percutaneous coronary intervention (PCI), did not meet exclusion criteria, and agreed with MRI before PCI. Subjects were divided into two groups according to the presence of ICL of cerebral microbleeds or lacunar infarction. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Clinical outcome was defined as a composite of cardiovascular death, non-fatal myocardial infarction, stroke, unstable angina and heart failure. In total, 149 patients underwent brain MRI. Patients with ICL (n=55) had significantly higher baPWV than those without ICL (1591-2204 vs. 1450-1956 cm per sec; P=0.009). A multivariate analysis showed that male sex (odds ratio (OR), 3.15; 95% confidence interval (CI), 1.38-7.20; P=0.006) and baPWV (OR, 1.001; 95% CI, 1.000-1.002; P=0.023) were predictors of ICL. In total, 12 patients experienced a cardiovascular event. The Kaplan-Meier analysis indicated a significantly higher incidence of cardiovascular events in patients with ICL (log-rank test: P=0.018). Multivariate Cox proportional hazards analyses indicated that ICL finding was a significant predictor of clinical outcome (hazard ratio, 3.41; 95% CI, 1.02-11.5; P=0.047). Patients with subclinical ICL had a higher baPWV and worse prognoses than those without ICL.

Homocysteine concentration in coronary artery disease: Influence of three common single nucleotide polymorphisms

Background and aimsWhether single nucleotide polymorphisms (SNPs) of homocysteine metabolism enzymes influence the rate of cardiovascular (CV) events in coronary artery disease (CAD) patients remains controversial. Methods and resultsIn this analysis, 1126 subjects from the AtheroGene study with CAD and 332 control subjects without known CAD were included. The following SNPs were investigated: methylentetrahydrofolate reductase (MTHFR-C667T), methionin synthetase (MS-D919G), and cystathionin beta synthetase (CBS-I278T). The endpoint was the combination of cardiovascular death, stroke, and non-fatal myocardial infarction (N = 286). The median follow-up time was 6.4 years. Kaplan–Meier curve analysis showed an increasing event rate with rising homocysteine levels (p < 0.001) in CAD patients. Further, in Cox-Regression analysis homocysteine was a predictor of the endpoint with a hazard ratio (HR) of 6.5 (95% CI: 2.9–14.6, p < 0.001) in the adjusted model including cardiovascular risk factors. Of the three SNPs, homozygous MTHFR SNP increased homocysteine levels significantly in patients with CAD and individuals without CAD (both p < 0.001). The SNPs in MS and CBS were not related to relevant changes in homocysteine levels in CAD patients or controls. The different SNPs of MTHFR, MS, and CBS were not related to an increased event rate. ConclusionHomocysteine level is a strong predictor of CV events. Subjects with and without CAD and SNPs in the enzyme MTHFR had increased homocysteine levels. This was not observed for MS and CBS SNPs. Although MTHFR SNPs alter homocysteine levels in patients and controls, these polymorphisms had no impact on prognosis in CAD patients.